HomeMy WebLinkAbout14040118 Application f I,
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�` `��""�� CITY OF C�RIVIEL / CLAY TOWNSHIP PERMIT # ��� I l 4�
. RESIDENTIAL.IMPROVEMENT LOCATION PERMIT APPLICATION Sewer / Wa er U ility
�xoux� For NewBtructures,Additions,Remodels,and Accessory Structures Permit�$,�1L7
BUILDER� NAME PHONE � , FAX
oF Va��coCo t� rne.l �17�J 7- �lBGG ��17�(�7-lG� I
RECORD STREEf ADDRE55 CITY STATE ZI
�7 0 � l�� � � �'1'�1� . '�(06�3
E-MAI4ADDRE55 BESf METHOD�OF -7
IS L/v �o,-mh«v/o cz9 �. �m wr CONTACT 3 I 7'SS /� fO�L
PLUMBING NA E 5TATEOFINDIANA• /� /� PIUMBINGCODE
CONTRACTOR �• G�(C LICENSE NUMBER / 730071"�/j O IRC O UPC
�� I (J✓Y�
PROPERTY NAME �I /_ � PHONE ,y� FAX
OWNER ��l�bGiQ�O U�-,SrDY�/i Q, , tD ' '�D UU ���86 ' �
STREEf�ADDRESS C STATE ZIP
� �. ��`'— Sf� ���1 Z6 ���33
PRO,�ECT LOT NUMBER SUBDIVISION NAME SECTION ,
LOCATION ' 1 a S
STR ET�A DRESS . CI STATE ZIP
����u �/�,h U«�s C7� �,�-n�-e�l _rrv �� 3
TAl(MAqP PGARCEL NUMBER 1 J ZONING FLOOD ZONE/5
�c/�_/�1��� �7 � ���
LOTSPLIf SE � UTILITY TERUTILITY SEWER/WATER , � �/�' ��
0 VES O NO � C��/'�'lQ� UTILITfES EXCAVATOR � �
(� TYPE OF T,��/'PF,OFCON RUCTION MASTERPERMIf F OORPLAN !I � I
PERMIT tl „NGLE FAMILY O TWO FAMILY � 70WNHOME 0 YES O fV0 ��r �W C�-h
TYPyOFIMPROVEMENT EARLY RELEASE
lB�NEW STRUCTURE O. REMODEL � ATTACHED GARAGE O ACCESSORY BUILDING
. � ADDITION-O Room/5 �Porch �Deck O &45EMENT FMISH 0 DETACHED GARAGE O DEMOLITION � YES � NO
PRO.�ECT P�N�COMMISSION/BZA/BPW DOCKEf NUMBER/5 AND/OR ESTIMATED COST I SQUARE FOOTAGE
TAC DATE/5 OF CONSTRULTION, tJ;�r'1 U�U S / � 7
� EXCLUDING LAND /��V .
'PDFPLANS TYPE OFFOUNDATIO�N/ MANUPACfU1�ED SUMP UMP PORCH
❑ �CD � E-MAIL O SLAB H BASEMENT-O WALK-Ol1T �. � /
O CRAWLSPACE 0 POSf&BEAM O �POST&P � �C � �f; u O��E 2 0 YES q'NO 9^!ES 0 NO
STATE OF �DR NUMBER RELEAS€DATE CON5fRUCfION OCCUPANCY CLA55
INDIANA \�N
CDR SCOPE OF RELEASE � ���\Ops �� � � TYPE OF RELEASE
FORTOWNHOMES � FDN O STR ���_y�,Y2.0 O � Egi q PLUM q SPKLR O OTHER
� i�� cAa�' EL � ' BY
For Single��amily and T��pffly�el��� �i�� alidbnly if construction mmmences within 180 days olthe date of issuance of this permit and
must be com leted, v�iy t e,L� t �ssued,within IS months ofthe dace oLissuance.�Class 1 Structure Permits are sub'ect[o the State
�
of Indiana�C neral A�n�tivA�����C 12) egarding expiretion time Games(or beginning aud completing construction. ,
I�the undereigned�agree that an j� ��Nruc2ion�enlargement,rebcatiun�or alteretion of a strucYUre�or any change in�the use ofland or
stmcmres requested by ffiis �J�' lp•�ly�w,th and conform to all aPPlicable lawspfthe Sta[e of Indiana and the°"Loning Ordinance ofCarmcl �
Indiana-.1993"(U289)an�iie�n�s,ad�ted under authority ofl.C.36-7 ec seq�General Assembly of the State of Indiana�and all Aets amendatory
themto. 1 Curther certify tha\l���kitchen�bath�and floor drains are mnntt'ted to the sanitary xwen J further certiLy tkut the construction will no[be
used or occu ied until a�[ficafe of ccupancy has tieen is"sued by the Depa/rtment oCCommunity Services�Cartnel�Indiana.
��/ ���/ /" CN/fa�//'lr �� — � �
aL�RMOwner � orizedAgent PrintedNa Date
�......................................................................................• ...............................................................................................�
REQIIIRED BASE INSPECTIONS * � PERMIT FEES i
*Additional insPe tions may be reyuired. i Filing /Review 1 l I � � Re-Review
�j 1I �
1 ,..// �J/ t Base Inspections ��a , 5e�
� VJ ower Footing YJ ough-In Id ' al /^
: Cert.of OccuPancy . �✓ � Other
t �pper Footing �eter Base �
� P.R.I.F. I (�( ,O(�
� ❑ Underslab ~2 + � � (`��
TOTAL v� �•t
, O � � . �L �IT
� Reriewed/Ael ased—DePartrnent o(Communi[y Services �� Uate ; ; Fee Recei eA—DePart�ent Copnmunity Services Date ;
f...................................................................... ..............: �.............................:.....:.:........................................................�
S:WeemhsVrorms�AppGcatiensLLtuidentiall[f.P AppGCetion�2009-08 lsst UpdareA O8/132009